Elective operations performed for duodenal ulcer, with their mortality

Abstract The second survey sponsored by the Ohio Chapter of the American College of Surgeons was designed to study the frequencies with which six standard surgical procedures were electively employed for chronic duodenal ulcer, and their mortality, and to compare them with the frequencies and the mortality in the first survey. These procedures were gastrectomy, gastrojejunostomy, and pyloroplasty, each with or without vagotomy. There were records in thirty-five Ohio hospitals of 6,259 patients operated on between 1957 and 1966 available for study. The over-all mortality of 2.6 per cent represented a reduction from the over-all mortality of 4.3 per cent in the first survey. In these hospitals a smaller number of gastric resections and a larger number of drainage procedures were performed in this period studied than during the first. Vagotomy was performed more frequently in both groups than previously. A great majority of operations were performed by "qualified" surgeons, and only 2 per cent were performed by so-called "unqualified" surgeons. The mortality of patients operated on by "qualified" surgeons (2.3 per cent) was lower than that of patients operated on either by residents (3.5 per cent) or by "unqualified" surgeons (3.8 per cent). These findings are in contrast to those of the previous study, in which the experience of the surgeon did not appear to exert a significant influence. The size of the hospital, the size of the community, and whether the hospital has a closed or an open staff did not seem to have much effect on the over-all mortality. Gastrectomy with or without vagotomy had a significantly greater mortality (3 per cent) than the drainage procedures with or without vagotomy (1.8 per cent).